糖尿病肾病临床诊疗进展
Advances in Clinical Diagnosis and Treatment of Diabetic Kidney Disease
DOI: 10.12677/ACM.2023.1361319, PDF,   
作者: 陈思凝, 刘璠娜*：暨南大学第一临床医学院，广东 广州；暨南大学附属第一医院(华侨医院)肾内科，广东 广州
关键词: 糖尿病；糖尿病肾病；临床诊疗；Diabetes； Diabetic Kidney Disease； Clinical Diagnosis and Treatment
摘要: 糖尿病是一种发病率逐年升高并且造成我国沉重公共卫生财政负担的慢性疾病，糖尿病肾病是其常见的微血管并发症之一，随着糖尿病患者数量的增加，在全球范围内，糖尿病导致的慢性肾脏病患者比例明显增加。目前暂无糖尿病肾病特效治疗的药物，大多是通过控制血糖以延缓疾病的发生发展。而由于DKD早期症状不明显或患者缺乏对于糖尿病肾病的认识，患者未能及时就医，或者忽略筛查及定期随访的重要性等，最终导致终末期肾病甚至死亡。因此加强糖尿病患者对于糖尿病肾病的了解和科普宣教是很有必要的。本文综述了糖尿病肾病临床诊疗相关研究进展，为糖尿病肾病的防治提供依据。
Abstract: Diabetes, causing heavy public health financial burden, is one of chronic diseases. Diabetic kidney disease (DKD) is prevalent chronic micro-vascular complications of diabetes. As the number of pa-tients with diabetes increases, the proportion of patients with chronic kidney disease due to diabe-tes increases significantly in the world. Currently, the treatment of DKD is limited and there is no unified treatment plan for DKD patients. Due to the lack of awareness of DKD, lots of patients with DKD could not be diagnosed and treated in time and eventually caused renal failure. So, it is neces-sary to strengthen the understanding about DKD for diabetic patients. This article reviews the clin-ical diagnosis and treatment of DKD, which provides reference for the prevention and treatment of DKD.
文章引用：陈思凝, 刘璠娜. 糖尿病肾病临床诊疗进展[J]. 临床医学进展, 2023, 13(6): 9426-9432. https://doi.org/10.12677/ACM.2023.1361319

参考文献

[1] Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B.B., Stein, C., Basit, A., Chan, J.C.N., Mbanya, J.C., Pavkov, M.E., Ramachandaran, A., Wild, S.H., James, S., Herman, W.H., Zhang, P., Bommer, C., Kuo, S., Boyko, E.J. and Magliano, D.J. (2022) IDF Diabetes Atlas: Global, Regional and Country-Level Diabetes Prevalence Estimates for 2021 and Projections for 2045. Diabetes Research and Clinical Practice, 183, Article ID: 109119. [Google Scholar] [CrossRef] [PubMed]
[2] Forbes, J.M. and Fotheringham, A.K. (2017) Vascular Com-plications in Diabetes: Old Messages, New Thoughts. Diabetologia, 60, 2129-2138. [Google Scholar] [CrossRef] [PubMed]
[3] Forbes, J.M. and Cooper, M.E. (2013) Mechanisms of Diabetic Complications. Physiological Reviews, 93, 137-188. [Google Scholar] [CrossRef] [PubMed]
[4] Umanath, K. and Lewis, J.B. (2018) Update on Diabetic Nephropathy: Core Curriculum 2018. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 71, 884-895. [Google Scholar] [CrossRef] [PubMed]
[5] Yang, C., Wang, H., Zhao, X., Matsushita, K., Coresh, J., Zhang, L. and Zhao, M.H. (2020) CKD in China: Evolving Spectrum and Public Health Implications. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 76, 258-264. [Google Scholar] [CrossRef] [PubMed]
[6] Koye, D.N., Shaw, J.E., Reid, C.M., Atkins, R.C., Reutens, A.T. and Magliano, D.J. (2017) Incidence of Chronic Kidney Disease among People with Diabetes: A Systematic Review of Observational Studies. Diabetic Medicine: A Journal of the British Diabetic Association, 34, 887-901. [Google Scholar] [CrossRef] [PubMed]
[7] Rodriguez, F., Lee, D.J., Gad, S.S., Santos, M.P., Beetel, R.J., Vasey, J., Bailey, R.A., Patel, A., Blais, J., Weir, M.R. and Dash, R. (2021) Real-World Diagnosis and Treatment of Diabetic Kid-ney Disease. Advances in Therapy, 38, 4425-4441. [Google Scholar] [CrossRef] [PubMed]
[8] McGrath, K. and Edi, R. (2019) Diabetic Kidney Disease: Diag-nosis, Treatment, and Prevention. American Family Physician, 99, 751-759.
[9] Afkarian, M., Zelnick, L.R., Hall, Y.N., Heagerty, P.J., Tuttle, K., Weiss, N.S. and de Boer, I.H. (2016) Clinical Manifestations of Kidney Disease among US Adults with Diabetes, 1988-2014. JAMA, 316, 602-610. [Google Scholar] [CrossRef] [PubMed]
[10] Yamanouchi, M., Furuichi, K., Hoshino, J., Ubara, Y. and Wada, T. (2020) Nonproteinuric Diabetic Kidney Disease. Clinical and Experimental Nephrology, 24, 573-581. [Google Scholar] [CrossRef] [PubMed]
[11] 中华医学会糖尿病学分会微血管并发症学组. 中国糖尿病肾脏病防治指南(2021年版) [J]. 中华糖尿病杂志, 2021, 13(8): 762-784.
[12] Barr, E.L.M., Barzi, F., Hughes, J.T., Jerums, G., Hoy, W.E., O’Dea, K., Jones, G.R.D., Lawton, P.D., Brown, A.D.H., Thomas, M., Ekinci, E.I., Sinha, A., Cass, A., MacIsaac, R.J. and Maple-Brown, L.J. (2018) High Baseline Levels of Tumor Necrosis Factor Receptor 1 Are Associated with Progression of Kidney Disease in Indigenous Australians with Diabetes: The eGFR Follow-up Study. Diabetes Care, 41, 739-747. [Google Scholar] [CrossRef] [PubMed]
[13] Pavkov, M.E., Weil, E.J., Fufaa, G.D., Nel-son, R.G., Lemley, K.V., Knowler, W.C., Niewczas, M.A. and Krolewski, A.S. (2016) Tumor Necrosis Factor Recep-tors 1 and 2 Are Associated with Early Glomerular Lesions in Type 2 Diabetes. Kidney International, 89, 226-234. [Google Scholar] [CrossRef] [PubMed]
[14] Chauhan, K., Verghese, D.A., Rao, V., Chan, L., Parikh, C.R., Coca, S.G. and Nadkarni, G.N. (2019) Plasma Endostatin Predicts Kidney Outcomes in Patients with Type 2 Diabetes. Kidney In-ternational, 95, 439-446. [Google Scholar] [CrossRef] [PubMed]
[15] Mori, Y., Ajay, A.K., Chang, J.H., Mou, S., Zhao, H., Kishi, S., Li, J., Brooks, C.R., Xiao, S., Woo, H.M., Sabbisetti, V.S., Palmer, S.C., Galichon, P., Li, L., Henderson, J.M., Kuchroo, V.K., Hawkins, J., Ichimura, T. and Bonventre, J.V. (2021) KIM-1 Mediates Fatty Acid Uptake by Renal Tubular Cells to Promote Progressive Diabetic Kidney Disease. Cell Metabolism, 33, 1042-1061.e7. [Google Scholar] [CrossRef] [PubMed]
[16] Mogensen, C.E., Christensen, C.K. and Vittinghus, E. (1983) The Stages in Diabetic Renal Disease: With Emphasis on the Stage of Incipient Diabetic Nephropathy. Diabetes, 32, 64-78. [Google Scholar] [CrossRef] 
[17] Biesenbach, G., Bodlaj, G., Pieringer, H. and Sedlak, M. (2011) Clinical versus Histological Diagnosis of Diabetic Nephropathy—Is Renal Biopsy Required in Type 2 Diabetic Patients with Re-nal Disease? QJM: An International Journal of Medicine, 104, 771-774. [Google Scholar] [CrossRef] [PubMed]
[18] 中华医学会肾脏病学分会专家组. 糖尿病肾脏疾病临床诊疗中国指南[J]. 中华肾脏病杂志, 2021, 37(3): 255-304.
[19] ElSayed, N.A., Aleppo, G., Aroda, V.R., Bannuru, R.R., Brown, F.M., Bruemmer, D., Collins, B.S., Cusi, K., Das, S.R., Gibbons, C.H., Giurini, J.M., Hilliard, M.E., Isaacs, D., Johnson, E.L., Kahan, S., Khunti, K., Kosiborod, M., Leon, S.K. Lyons, L. Murdock, M.L. Perry, P. Prahalad, R.E. Pratley, J.J. Seley, R.C. Stanton, J.K. Sun, C.C. Woodward, J., Young-Hyman, D., Gabbay, R.A. and on Behalf of the American Diabetes Association. (2023) In-troduction and Methodology: Standards of Care in Diabetes—2023. Diabetes Care, 46, S1-S4. [Google Scholar] [CrossRef] 
[20] Improving Global Outcomes (KDIGO) Diabetes Work Group (2022) KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney International, 102, S1-S127. [Google Scholar] [CrossRef] [PubMed]
[21] Hostetter, T.H., Meyer, T.W., Rennke, H.G. and Brenner, B.M. (1986) Chronic Effects of Dietary Protein in the Rat with Intact and Reduced Renal Mass. Kidney International, 30, 509-517. [Google Scholar] [CrossRef] [PubMed]
[22] Chen, Y., Wang, X., Jia, Y., Zou, M., Zhen, Z. and Xue, Y. (2022) Effect of a Sodium Restriction Diet on Albuminuria and Blood Pressure in Diabetic Kidney Disease Patients: A Meta-Analysis. International Urology and Nephrology, 54, 1249-1260. [Google Scholar] [CrossRef] [PubMed]
[23] Giacchetti, G., Sechi, L.A., Rilli, S. and Carey, R.M. (2005) The Renin-Angiotensin-Aldosterone System, Glucose Metabolism and Diabetes. Trends in Endocrinology and Metabolism, 16, 120-126. [Google Scholar] [CrossRef] [PubMed]
[24] Lewis, E.J., Hunsicker, L.G., Clarke, W.R., Berl, T., Pohl, M.A., Lewis, J.B., Ritz, E., Atkins, R.C., Rohde, R. and Raz, I. (2001) Renoprotective Effect of the Angiotensin-Receptor An-tagonist Irbesartan in Patients with Nephropathy due to Type 2 Diabetes. The New England Journal of Medicine, 345, 851-860. [Google Scholar] [CrossRef] 
[25] Donate-Correa, J., Luis-Rodríguez, D., Martín-Núñez, E., Tagua, V.G., Hernández-Carballo, C., Ferri, C., Rodríguez- Rodríguez, A.E., Mora-Fernández, C. and Navarro-González, J.F. (2020) Inflammatory Targets in Diabetic Nephropathy. Journal of Clinical Medicine, 9, Article 458. [Google Scholar] [CrossRef] [PubMed]
[26] Thallas-Bonke, V., Thorpe, S.R., Coughlan, M.T., Fukami, K., Yap, F.Y., Sourris, K.C., Penfold, S.A., Bach, L.A., Cooper, M.E. and Forbes, J.M. (2008) Inhibition of NADPH Oxidase Pre-vents Advanced Glycation End Product— Mediated Damage in Diabetic Nephropathy through a Protein Kinase C-α-Dependent Pathway. Diabetes, 57, 460-469. [Google Scholar] [CrossRef] [PubMed]
[27] Fioretto, P., Zambon, A., Rossato, M., Busetto, L. and Vettor, R. (2016) SGLT2 Inhibitors and the Diabetic Kidney. Diabetes Care, 39, S165-S171. [Google Scholar] [CrossRef] 
[28] Dia, B., Alkhansa, S., Njeim, R., Al Moussawi, S., Farhat, T., Haddad, A., Riachi, M.E., Nawfal, R., Azar, W.S. and Eid, A.A. (2023) SGLT2 Inhibitor—Dapagliflozin Attenuates Diabe-tes-Induced Renal Injury by Regulating Inflammation through a CYP4A/20-HETE Signaling Mechanism. Pharmaceutics, 15, Article 965. [Google Scholar] [CrossRef] [PubMed]
[29] Tomita, I., Kume, S., Sugahara, S., Osawa, N., Yamahara, K., Yasuda-Yamahara, M., Takeda, N., Chin-Kanasaki, M., Kaneko, T., Mayoux, E., Mark, M., Yanagita, M., Ogita, H., Araki, S.I. and Maegawa, H. (2020) SGLT2 Inhibition Mediates Protection from Diabetic Kidney Disease by Promoting Ketone Body-Induced mTORC1 Inhibition. Cell Metabolism, 32, 404-419.E6. [Google Scholar] [CrossRef] [PubMed]
[30] Jongs, N., Greene, T., Chertow, G.M., McMurray, J.J.V., Lang-kilde, A.M., Correa-Rotter, R., Rossing, P., Sjöström, C.D., Stefansson, B.V., Toto, R.D., Wheeler, D.C. and Heerspink, H.J.L. (2021) Effect of Dapagliflozin on Urinary Albumin Excretion in Patients with Chronic Kidney Disease with and without Type 2 Diabetes: A Prespecified Analysis from the DAPA-CKD Trial. The Lancet Diabetes & Endocrinology, 9, 755-766. [Google Scholar] [CrossRef] 
[31] Barrera-Chimal, J., Lima-Posada, I., Bakris, G.L. and Jaisser, F. (2022) Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease—Mechanistic and Therapeutic Effects. Nature Reviews Nephrology, 18, 56-70. [Google Scholar] [CrossRef] [PubMed]
[32] Frampton, J.E. (2021) Finerenone: First Approval. Drugs, 81, 1787-1794. [Google Scholar] [CrossRef] [PubMed]
[33] Bakris, G.L., Agarwal, R., Anker, S.D., Pitt, B., Ruilope, L.M., Rossing, P., Kolkhof, P., Nowack, C., Schloemer, P., Joseph, A. and Filippatos, G. (2020) Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. The New England Journal of Medicine, 383, 2219-2229. [Google Scholar] [CrossRef] 
[34] Filippatos, G., Anker, S.D., Agarwal, R., Ruilope, L.M., Rossing, P., Bakris, G.L., Tasto, C., Joseph, A., Kolkhof, P., Lage, A. and Pitt, B. (2022) Finerenone Reduces Risk of Incident Heart Failure in Patients with Chronic Kidney Disease and Type 2 Diabetes: Analyses from the FIGARO-DKD Trial. Circulation, 145, 437-447. [Google Scholar] [CrossRef] 
[35] 李金菊, 刘旺华, 李花, 李甜, 夏琳, 何翔. 糖尿病肾病不同证型舌象的客观化研究[J]. 亚太传统医药, 2021, 17(4): 161-165.
[36] 郑依玲, 梅全喜, 李文佳, 唐志芳, 钱正明, 陶盛昌, 董鹏鹏. 冬虫夏草的药用历史及现代服用方法探讨[J]. 中药材, 2017, 40(11): 2722-2725.
[37] 陈仁慈, 项洁琼, 陈洪宇. 冬虫夏草治疗糖尿病肾病疗效的系统评价[J]. 中国中西医结合肾病杂志, 2017, 18(4): 340-344.
[38] Wang, C., Hou, X.X., Rui, H.L., Li, L.J., Zhao, J., Yang, M., Sun, L.J., Dong, H.R., Cheng, H. and Chen, Y.P. (2018) Artificially Cultivated Ophiocordyceps sinensis Alleviates Diabetic Nephropathy and Its Podocyte Injury via Inhibiting P2X7R Expression and NLRP3 Inflammasome Activation. Journal of Diabetes Re-search, 2018, Article ID: 1390418. [Google Scholar] [CrossRef] [PubMed]
[39] 徐喆, 赵凯, 李志军. 冬虫夏草对糖尿病肾病大鼠肾小管细胞中AMPK/mTOR信号传导途径的影响[J]. 中国现代医学杂志, 2018, 28(3): 1-5.
[40] Wu, W.T., Hsu, T.H., Lee, C.H. and Lo, H.C. (2020) Fruiting Bodies of Chinese Caterpillar Mushroom, Ophiocordyceps sinensis (Ascomycetes) Allevi-ate Diabetes-Associated Oxidative Stress. International Journal of Medicinal Mushrooms, 22, 15-29. [Google Scholar] [CrossRef] 
[41] 中国医师协会中西医结合医师分会内分泌与代谢病学专业委员会. 糖尿病肾病病证结合诊疗指南[J]. 中医杂志, 2022, 63(2): 190-197.

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